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At least 811 records · Page 45Linked to original sources
PubMedDate not supplied

Metabolic response to postoperative parenteral nutrition in infants.

Thirty-five infants who had tracheoesophageal fistula, esophageal stenosis, anal atresia, or Hirschsprung's disease were managed with various types of parenteral solution after their radical operations. The infants were divided into 6 groups and given 1) the usual low calorie infusion consisting of 5% glucose, water, and electrolytes, 2) high calorie formula consisting of 21 g/kg/day glucose, and 4 g/kg/day synthesized crystalline L-amino acids, 3) solutions without phosphate, 4) solutions of Cal/N ratio 200 providing 4 g/kg/day amino acids, 5) solutions of Cal/N ratio 400 providing 2 g/kg/day amino acids, and 6) a regimen containing fat emulsion. Nitrogen (N) and phosphorus (P) balances, blood urea nitrogen (BUN), blood glucose, plasma phosphate, immunoreactive insulin (IRI), and non-esterified fatty acid (NEFA) values were investigated. Parenteral solutions, providing 100 Cal/kg/day of Cal/N ratio 200, yielded sufficient positive N balance (120 mg/kg/day average). High calorie solutions without phosphate caused marked hypophosphatemia (0.3 mEq/1) with undetectable P in 24-hr urine. P balance correlated with N balance. Solutions of Cal/N 400 induced a lower BUN level, although there was a cumulative negative N balance. Solutions of Cal/N 200 induced higher levels of IRI and lower glucose than those of Cal/N 400. Increased IRI response and remarkedly decreased NEFA levels were seen in the group administered solutions without fat. Solutions with fat emulsion suppressed IRI response and improved the level of plasma NEFA.

Body Weight↗
PubMed2000

Outcome of patients receiving photodynamic therapy for early esophageal cancer.

PURPOSE: Photodynamic therapy (PDT) has shown remarkable activity in a variety of human cancers. In the present study, we report the effects of PDT on inoperable early-stage esophageal cancer. METHODS AND MATERIALS: Sixty-two patients were treated with an argon dye laser (630 nm wavelength, 300-800 mW of power, energy dose of 200-300 J/cm) after intravenous injection of 5 mg/kg of hematoporphyrin derivative. Eighteen patients (29.5%) had in situ carcinoma (Tis), 30 (48.5%) had T1-stage cancer, 7 (11%) had T2-stage cancer, and 7 (11%) had recurrent disease in the anastomotic area after previous surgery without evidence of invasion outside the lumen. Patients with residual disease after two rounds of PDT received definitive radiotherapy. Patients were evaluated for response to therapy and survival. The follow-up time ranged from 3 to 90 months (median, 32 months). RESULTS: The complete response (CR) rate was 37% (23 of 62) in patients who received PDT alone and 82% (51 of 62) in those who also received radiotherapy. The CR rate after PDT alone was statistically higher (p = 0.04) for patients who had Tis/T1 lesions (21 of 48; 44%) than for those with T2-stage disease (2 of 7; 28%) or recurrent tumors (0 of 7; 0%). Fifty-two percent of patients who had CR following PDT alone did not suffer local tumor recurrence. The median local progression-free survival times after PDT and additional radiotherapy (in cases with incomplete response) was 49 months for Tis- and T1-stage lesions, 30 months for those with T2-stage disease, and 14 months for patients with locally recurrent disease. Patients who completely responded to PDT had a median overall survival (OS) of 50 months, which was significantly longer (p < 0.003) than that of patients not responding to PDT. Toxicity was minimal; we recorded three cases of esophageal stenosis (7%) and one case of tracheo-esophageal fistula (2.5%) after combined PDT and radiotherapy. CONCLUSION: PDT is an effective regimen for early esophageal cancer, giving a CR rate of about 40%, long-term local control and favorable overall survival. Additional radiotherapy in cases of incomplete response to PDT is effective and potentially curative in another 45% of cases.

Antineoplastic Agents↗
PubMed1997

A case of esophagectomy for corrosive esophageal stricture caused by swallowing strong alkali. A case report.

We report herein the case of a 22-year old woman who underwent esophagectomy for corrosive esophageal stricture. This patient with mental disturbance swallowed a strong alkali in a suicide attempt and suffered from esophageal stenosis instead of steroid therapy. Because the stiffness and stricture of the esophagus proved to be refractory, transhiatal esophagectomy by blunt finger with gastroesophagostomy was performed four months after injury. Operative findings revealed severe stiffness and inflammation of the esophagus which had spread to the adjacent organs, especially the carina. As for pathological findings, most of the esophageal mucosa showed defects resulting from infiltration of inflammatory cells and capillary vascularization from the lamina propria to the extra-esophageal wall. The postoperative course was uneventful and perioperative psychological state had been stable leading to a decrease in tranquilizer dosage. This experience indicates that esophagectomy is the treatment of choice for such mental disturbed patients with severe stenosis.

Adult↗
PubMed2007

Regeneration of the esophagus using gastric acellular matrix: an experimental study in a rat model.

Recently, tissue engineering of the autologous esophagus has been thought to provide a promising strategy for esophageal substitution. In this study, gastric acellular matrix (GAM) was used as a scaffold for regeneration of the esophagus in a rat model. Usage of GAM has an advantage that naturally derived extracellular matrix autograft can be prepared less invasively in a clinical setting. Twenty-seven F344 female rats were used as recipients. Patch defects created in the abdominal esophagus were replaced by GAM patch grafts. The rats were sacrificed 1 week to 18 months after implantation. The specimen was examined macroscopically as well as microscopically. 5'-Bromo-2'-deoxyuridine (BrdU) proliferation assay was performed in six rats that were sacrificed 1, 2, and 4 weeks after implantation. Twenty-four rats survived without complications. The graft site did not show esophageal stenosis or dilatation in any rat. Keratinized stratified squamous esophageal mucosa was regenerated in the entire graft 2 weeks after implantation. Regeneration of the muscle layer or lamina muscularis mucosae in the graft site was not observed even 18 months after implantation. Marked incorporation of BrdU was observed only in the mucosal layer but not in the muscle layer. GAM patch graft provided satisfactory mucosal regeneration of the esophagus without stenosis or dilatation, although muscle regeneration was still a future challenge.

Animals↗
PubMed1992

[Iatrogenic foreign body of the esophagus].

The AA. report the case of a 79 years-old patient suffering an esophageal stenosis managed with intubation (Celestin's tube). This instance shows the good tolerance of the prosthesis by the patient as well as the undue of its stay. And by the way, the simplicity of its removal with a rigid esophagoscope, as was the present case. The paper contemplates a brief review of the indications for esophageal intubation and possible complications when dealing with organic stenosis of the esophagus.

Aged↗
PubMed1992

Comparison of different ligature materials used for T-tube esophageal exclusion.

Four different ligature materials--plain catgut, chromic catgut, dexon and silk--were used for ligature of the distal arm during T-tube exclusion of the cervical esophagus in 12 dogs. Ligature by plain catgut was maintained for only a short period, but the duration of esophageal occlusion with the other three ligature materials was around 10 days. Ligated esophageal segments were examined grossly and histologically two months after the procedure. The diameter of the esophageal lumen in the ligated segments had become smaller compared with the neighboring normal esophageal lumen. The most prominent histologic changes were atrophy and fibrosis of the muscle coat, vessel congestion and inflammatory cell infiltration in the ligated segments. These tissue reactions were more severe in the chromic catgut and silk ligatures. Among the 11 evaluable dogs, four had symptoms of dysphagia after removal of the T-tube. All four dogs had a sinus discharge and granuloma formation at the T-tube esophagostoma. The diameter of the esophageal lumen was more constricted in dogs with dysphagia. Among the four ligature materials, dexon had the advantages of a long duration of occlusion, less tissue fibrosis and little sequel of esophageal stenosis, making it the most suitable for ligature during esophageal exclusion.

Animals↗
PubMed1995

Long-term survival after photodynamic therapy for esophageal cancer.

BACKGROUND/AIMS: Photodynamic therapy (PDT) has been adapted to the endoscopic treatment of digestive cancer, but its indications and efficacy remain uncertain. The aim of this study was to assess its feasibility in the curative treatment of small esophageal tumors. METHODS: From 1983 to 1991, PDT was used to treat 123 patients with esophageal cancer who were recommended for nonsurgical treatment of squamous cell carcinoma (n = 104) and adenocarcinoma (n = 19). Endoscopic ultrasonography (EUS) was performed in 88 patients; 61 were staged uT1 and 27 were staged uT2. A hematoporphyrin derivative was injected 72 hours before laser irradiation with a 630-nm dye laser. PDT was applied alone in 56 patients and as part of a multimodal protocol in the 67 others. RESULTS: The complete response rate at 6 months was 87%. The 5-year survival rate was 25% +/- 6%, and the 5-year disease-specific survival rate was 74% +/- 5%. The complete response rate and survival rate were not different (1) between the PDT alone and the PDT multimodal treatment groups, (2) between the adenocarcinoma and squamous cell carcinoma groups, and (3) between the uT1 and uT2 EUS groups. PDT-related complications were esophageal stenosis (n = 43) and cutaneous photosensitization (n = 16). CONCLUSIONS: In patients with small esophageal tumors who pose high surgical risk, photodynamic therapy is an effective treatment.

Adenocarcinoma↗
PubMed1992

[Abrikossof's tumor of the esophagus. An original case. Review of the literature].

Granular-cell tumors (GCT), also called Abrikossof's tumors, are generally benign, ubiquitous tumors. An original case of granular-cell tumor of the esophagus is reported. The symptoms included dysphagia and pyrosis. Fiberendoscopy showed a peptic esophageal stenosis with ulcerations confirmed by biopsy. CT showed a round thickening of the esophageal wall, localized in height. This lesion had previously been the object of several dilatation attempts. Esophagectomy with esogastric anastomosis in the thorax was performed. The histological study allowed diagnosing a granular-cell tumor, though one of a very peculiar type: misleading symptoms, tumor infiltrating the whole height of the esophagus and a circular area. Ninety cases of granular-cell tumors are reported in the literature; they are associated with a cancer of the air passages or of the digestive tract in 11% of cases. The cancer often appears secondarily, which requires lengthy surveillance. We do not know if this association is directly related or accidental. We have found no identical case of such a lesion, involving both the whole circumference and the whole height of the esophagus, in the literature.

Esophageal Neoplasms↗
PubMedDate not supplied

[Suicides and attempted suicides with corrosive substances 1968-2000].

The authors analyzed attempted and committed suicides with corrosive substances registered at the Department of the General Hospital of the Health Center "Dr. Gere Istvan" in Senta in the period 1968-2000. Out of 42 registered, there were 33 attempted and 9 committed suicides with corrosive substances. In regard to the total number of suicides attempted and committed with poisoning, these poisonings take the last place, that is they come after suicides by drug intoxication, organophosphorus compounds and rodenticides. Data analysis included substance, sex, education level, marital status, occupation and underlying disease. It has been established that in regard to attempted suicides there is no difference in sex distribution, but in committed suicides females prevailed. Most subjects were married, had elementary education and by profession most were housewives, workers and agricultural workers. The most common motives for suicide were family and marital conflicts as well as alcohol consumption. Depression and alcoholism were most frequent underlying diseases. According to gathered data, authors conclude that suicide attempts with corrosive substances are decreasing from year to year. Suicides are mostly attempted with concentrated alkalies, but committed with concentrated acids. Depression and alcoholism are the commonest underlying diseases in patients attempting suicide. Esophageal stenosis is the most common complication in attempted suicides, whereas gastric perforation with peritonitis and esophageal perforation with mediastinal abscess are the most frequent complications in committed suicides.

Caustics↗